Provider Demographics
NPI:1285953976
Name:PINNICLE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:PINNICLE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERIASAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-295-1008
Mailing Address - Street 1:2911 ROUTE 88
Mailing Address - Street 2:SUITE E8
Mailing Address - City:POINT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2871
Mailing Address - Country:US
Mailing Address - Phone:732-295-1008
Mailing Address - Fax:732-899-5733
Practice Address - Street 1:2911 ROUTE 88
Practice Address - Street 2:SUITE E8
Practice Address - City:POINT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742-2871
Practice Address - Country:US
Practice Address - Phone:732-295-1008
Practice Address - Fax:732-899-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07322300103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058676AJ1OtherMEDICARE PTAN - JAYANTHI PERIASAMY, MD
NJ879207ZAJ1OtherMEDICARE PTAN - CHOWDHURY AZAM, MD